#I trained a 60 year old today who has worked in medical billing for 30 years

[vistakai]

Hey! We have got to stop hiring people if they can't use a computer!

[itshistoryyall]

Pandemics

The history of pandemics is, as I’m sure you can surmise, quite extensive. As far back as the history of humanity goes, pandemics, disease, and death has kept close proximity. We have always faced hardships, but the intriguing part, is how we have survived. It’s important to remember that during these tough times where it seems like we might be isolated, afraid, or scared. We, as a community, have always persevered, and this time is no different. We will pull-through, we will move forward, and we will survive. BUT, it’s very important that we start by passing on good, researched information, help out our neighbors, and keep in mind that this situation is above all, NOT about you.

Beginning in the 1300s with the bubonic plague, humanity started seeing an organized effort to quell emerging diseases. At first glance, I would be want to say that we, as modern humans, have not experienced a pandemic threat on this particular level, but that would not be entirely true. It’s more like true, but with an asterisk--more on that in a minute (I’ll be sure to put an asterisk so you know). The plague, I won’t spend too much time on because it could in it’s own right be an entire series of posts, but what’s important to know is that this is where we, as humans, assessed a threat and decided that there should be some sort of concerted effort to suss out tactics to stop its progression. So, we won’t talk about how it spread here, but more specifically about statistics. It is estimated that around 30-60% of the world’s population was decimated by “the black death,” and to put that in numbers, an of an estimated 475 million people, around 350-375 million were left at the start of the 14th century. 

It’s important not to blame the animals for the spread of the plague though, they may have started it, but uninformed humans made it the pandemic that it was (three times in history, I might add). The plague was thought to have been potentially airborne and close contact mixed with poor health conditions, malnutrition, and a general lack of knowledge for personal hygiene and the healthcare practices that we have today were simply a recipe for disaster. This disease spread rapidly from person to person, and ended up taking out over half of Europe’s population. It seems like a silly thing to compare that to what’s happening in our current day situation, but I would like to draw the parallel of what dangers an uninformed public can pose. The idea of quarantine began here in 1377, and though it was the right decision, the spread of the disease was not halted because of a lack of modern medical knowledge.

We don’t see a real protocol for quarantine until the mid 1600s when England passed a number of bills that standardized the process for disinfecting and cleaning people and ships suspected of being infected with the plague. Around this time, cases of smallpox and yellow fever were starting to pop up in America, and the implementation of regulations for dealing with the spread of disease was the responsibility of the state. We didn’t see national involvement in disease prevention until the late 1700s. If you’d like to know how old news anti-vaccers are, then you can look back to the beginnings of inoculations for smallpox that began in the late 1600s around 1691. It was highly controversial to inoculate people and was more acceptable to mandate a quarantine for those suspected of having the disease.

When cholera began spreading across the world in the 18th century, quarantine practices were also scoffed at and for the most part considered unnecessary by most people. The resulting spread was exponential. The death rate was well over 1 million people and plenty of others had contracted cholera before the pandemic calmed down around 6 years after the initial outbreak thanks to a literal act of God, meaning, a severely cold winter killed off most of the mosquitoes that were carrying and transmitting cholera to humans and worsening the impact and spread. By the early 1900s an international Sanitary Conference was held where new articles were signed that reinvented methods of prevention of the spread of disease, and it couldn’t have come soon enough because a few years later (7 to be exact), a tremendous influenza epidemic hit the world hard. Known as Spanish Influenza, the world’s first introduction to the flu was not a pleasant experience.

The influenza pandemic came in three waves between 1918-1919, and was a disease that was completely unknown to professionals. The Office International d’Hygiène Publique (predecessor of the World Health Organization or WHO), located in Paris, France was all but useless in the immediate need for action to stop the spread of flu. As the world was suffering at the throes of the First World War, too little and too late was done to prevent the spread, but to no avail. Attempts were made to close public gathering places, schools, sporting events, and entertainment venues. Even Yale closed all on-campus meetings, but the extremely contagious virus was too widely spread for these uncoordinated and poorly-timed measures to prevent mass spread. Here we see the efforts of health experts encouraging people to self-quarantine and use social distancing measures, but by the time this was implemented, influenza had reached every part of the world and had progressed to a point where these measures were all but useless. What’s important about this history lesson is that these things would have helped had they been a preventative measure.

Influenza is unique in this time period because we also have our first instance of the impact that mass media would have on the outcome and public information about this virus. In Italy, newspapers were prevented from publishing the death count on a daily basis in order to keep the mass acute anxiety that was having an extreme impact on public morale and panic levels. However, war-torn nations were experiencing problems with accuracy and clarity of information regarding prevention of spread because of the censorship of media outlets at the time which worsened the impact of the pandemic as much as the war effort itself.

In 1933 the pathogen that causes influenza was found and we were able to start treating influenza, and creating a vaccine. Around 1940, the CDC was founded and established in Atlanta, Georgia as a base for all operations regarding the control and prevention of the spread of infectious diseases, and it was in direct relation to the spread of malaria in the 1940s. The CDC added a plague department in 1947 as well as an  Epidemiology Division and Veterinary Diseases Division. In 1951, the Epidemic Intelligence Service (EIS) and Field Epidemiology Training Programs (FETP) were established that now have international models based off of the American programs. The Venereal Disease Division was establishes in 1957, and in 1963 the Immunization program was established. The CDC has been widely influential in a number of preventative and creative approaches to preventing the spread of disease and abuse of medications in order to prevent immunity of viruses and bacteria to treatment. This organization is a world leader when it comes to establishing standards for handling anything from research to protocols for worldwide pandemics. If there was ever a time to trust the nerds it’s now.

And that brings us to today. So, what are we supposed to be listening to now? The professionals. The ones who have brought us from malaria to COVID-19, the place that has kept us informed about influenza since 1946, and the place that is the ONLY reason that penicillin still works as an antibiotic, the one-and-only, Center for Disease Control. This virus and its prevention has suffered from a large amount of disinformation and “fake news.” I would like to encourage everyone to take power over your own learning, to learn from the unintelligent and unfortunate dead, and to re-post only articles and information that you know to be true. Now, more than ever before is a time to learn from our own naive history, to realize that we have made these mistakes before, and to LISTEN to the pleas of our healthcare experts and government officials. These measures might seem superfluous, but they’re preventative and we need this virus to slow down or face the consequences a la Cholera. This is not something to not take seriously and now is not the time to be selfish. Help your fellow man. Stay home, even if you’re well, and remember that you’re saving lives--you hero, you ;)

“Those who cannot remember the past are condemned to repeat it”--George Santayana

https://www.cdc.gov/

[orbemnews]

Alibaba’s Big Fine Is a Warning Shot Beijing tightens the screws Over the weekend, Chinese officials fined Alibaba a record $2.8 billion over antitrust violations. It was the biggest penalty yet as the Chinese government scrutinizes Jack Ma’s business empire — and it served as a warning for the country’s other internet giants. The fine was linked to Alibaba’s locking of merchants into its sales platform, according to the Chinese market authority, and vastly exceeds the agency’s previous largest fine, a $975 million antitrust penalty imposed on Qualcomm in 2015. A commentary published in the state-run People’s Daily minutes after the Alibaba announcement called such regulation “a kind of love and care.” The fine will likely curb Alibaba’s ambitions. Like its American counterparts, the company argued that its sheer size and wealth of services are a net positive for consumers. But smaller rivals are now likely to find support from Beijing if they accuse Alibaba of anticompetitive practices in the future. “We accept the penalty with sincerity,” Alibaba said in a statement, and executives held a call today to say the fine, worth about 4 percent of revenue, wasn’t material to the e-commerce giant’s finances. Shareholders appeared relieved. Alibaba’s shares rose by more than 6 percent in Hong Kong trading. Beyond the fine, the company agreed to stop violating antimonopoly rules and submit compliance reports for three years. And today, the company said it would lower the fees it charges merchants and provide additional services. Alibaba’s shares are still down sharply from late last year, when the antitrust rumblings began. Alibaba suggested that rivals could be next. “The penalty issued today served to alert and catalyze companies like ours,” the company said in its statement. “It reflects the regulators’ thoughtful and normative expectations toward our industry’s development.” Unlike Alibaba, shares in Tencent and Baidu were down today, as other big internet businesses in China feared that they might be next. HERE’S WHAT’S HAPPENING An effort to unionize Amazon workers fails. Workers at a warehouse in Alabama overwhelmingly voted against the proposal, crushing one of the biggest drives to form a union in Amazon’s history. The lopsided result may prompt organized labor to try different tactics in the future. Jay Powell says the economy is at an “inflection point.” The Fed chair said on “60 Minutes” last night that the U.S. outlook had “brightened substantially” but warned that flare-ups in Covid-19 cases remain a risk. Speaking of virus risks: the South African variant may be able to evade some of the protection of the Pfizer-BioNTech vaccine. Microsoft may be close to striking another big acquisition. It is near a deal to buy Nuance Communications, the A.I. and speech recognition software company whose tech is tied to Apple’s Siri virtual assistant, Bloomberg reports. At a potential valuation of $16 billion, a transaction would be Microsoft’s biggest since buying LinkedIn for $26 billion. Preet Bharara is becoming a digital media executive. Vox Media agreed to buy Cafe Studios, the publisher behind “Stay Tuned With Preet,” the podcast hosted by the former Manhattan U.S. attorney. Mr. Bharara, who made his name prosecuting insider trading and terrorism cases, will join Vox as the creative director of Cafe. Two electric vehicle battery makers settle their feud. LG Energy Solution and SK Innovation reached an agreement to end their intellectual property dispute, with SK paying LG $1.8 billion in lump-sum and royalty payments. The settlement ends a fight that threatened the Biden administration’s climate agenda, as well as a big battery factory SK is building in Georgia. C.E.O.s talk politics Over the weekend, more than 100 corporate leaders held a conference call to discuss what they should do, if anything, to shape the debate around restrictive new voting laws under discussion across the U.S. Snap polls during the call suggested that most of the participants favor doing something, though what that would be isn’t yet clear. The voting-rights debate is fraught for companies, putting them at the center of an increasingly heated partisan battle. Ken Chenault, the former AmEx chief, and Ken Frazier, the current Merck C.E.O., urged the executives on the call to publicly state their support for broader ballot access, following their work gathering 70 fellow Black leaders to sign a letter calling on companies to fight bills that restrict voting rights, like the one that recently passed in Georgia. A new survey of Americans gives support for companies wading into politics. The data provided by Morning Consult was presented to the C.E.O.s on the call, which was convened by the Yale professor Jeffrey Sonnenfeld. Here are some highlights: 62 percent of “avid” baseball fans support M.L.B.’s decision to move the All-Star Game from Georgia in response to the state’s new voting restrictions. Support was lower among all adults (39 percent), but if the league was worried about the effect on its most dedicated fans, this is an important finding. 57 percent of Americans think companies should cut back on donations to elected officials who are working to limit voting rights. Nearly three-quarters of respondents said that the government should ensure equitable access to voting locations. More than half of Americans said they were more likely to buy from companies that promote certain social causes, including racial equality and civil rights, although support among Democrats was stronger than among Republicans on many of these issues. Among the handful of issues that would make Republicans less likely to buy from a company were support for the Black Lives Matter movement, abortion rights, stricter gun control, transgender rights and gay rights. “However glad we are to see a new generation’s evolving perspective on investing, our goal is not to make it easier for them to pile into and rush out of speculative meme stocks.” — Ron Kruszewski, the C.E.O. of Stifel, in his annual letter to shareholders. On due diligence and flying taxis Archer, the electric aircraft company, said earlier this month that it’s facing a federal investigation over allegations of I.P. theft. That’s not just a potential problem for Archer, which denies wrongdoing, but also for the investment bank Moelis & Company, which announced in February that a blank-check firm it was backing would acquire Archer in a deal that valued the company at $3.8 billion. Questions arise about due diligence. Archer revealed the federal investigation on the day a rival, Wisk, sued the company and accused it of stealing trade secrets and infringing on its patents. According to Wisk’s suit, it informed Archer of its concerns last year, before Archer’s deal with the Moelis-linked SPAC, known as Atlas Crest Investment. “They had to be aware of this — so what did they make of it?” said Kevin LaCroix, a lawyer and author of D&O Diary. Moving too quickly? I.P. theft claims are common in nascent industries like the one for electric air taxis, and Atlas may have dismissed the matter as a competitive tactic from a rival. But Atlas’s due diligence took a little over a month, according to regulatory filings. The SPAC led by Reid Hoffman took almost three times as long to run the rule over its acquisition of another rival, Joby. What about incentives? Moelis not only backed the Atlas SPAC but also served as its financial adviser and placement agent for the additional funding alongside the merger — roles that could earn it $30 million in fees, according to filings. Moelis bankers, including the chairman Ken Moelis, own a “substantial majority” of founder shares and warrants in the SPAC, which would be worthless if a deal isn’t done. There are “huge incentives” for SPAC deals to close, Mr. LaCroix said. “Does that create its own logic which kind of creates sort of a runaway freight train so that, if problems do emerge, they kind of get glossed over? That is the risk.” Baseball on the blockchain A classic American pastime — baseball-card collecting — is getting a 21st century update. The blockchain platform Worldwide Asset Exchange (WAX) and Topps, the collectibles and candy company, are launching NFTs, or nonfungible tokens, digitizing this season’s Major League Baseball trading card series. WAX minted more than a million NFTs for 75,000 digital card packs. The series, digitizes nearly 2,000 images to be sold in packs of six or 45 cards starting next week. William Quigley, WAX’s co-founder, said he expects “millions” in direct sales and a robust secondary market. For M.L.B., the tokens essentially act as an annuity, paying the league a fraction of every resale via conditions written into their code. That is a new source of revenue that didn’t exist with old-fashioned cards. Top Shots, the National Basketball Association’s NFTs, are among the most popular assets to take off in the recent crypto craze, generating nearly $150 million in sales over the past month alone, according to DappRadar. Digital tokens solve several problems, Mr. Quigley said. With standard cards it has been difficult to establish how many cards were issued and to ensure the authenticity of a supposedly rare one. NFTs have built-in authentication and verification data, and separate ownership from possession so that owners don’t need to amass physical goods in a world with “landfills worth of junk,” he said. Mr. Quigley himself is considering giving up on buying physical art. “I’m thinking I don’t like it,” he said. A home run in a hot market? Topps is riding high as the pandemic has driven new interest in memorabilia, especially trading cards. And NFTs are not the only hot trend Topps is betting on: the company is going public via SPAC in a deal that values it at $1.3 billion, DealBook reported last week. THE SPEED READ Deals Medline Industries, a maker of medical equipment, is reportedly weighing a sale that could value it at more than $30 billion. (WSJ) Didi Chuxing, the Chinese ride-hailing giant, is said to have hired Goldman Sachs and Morgan Stanley to lead its forthcoming I.P.O. in the U.S. (Reuters) Politics and policy David Cameron, the former British prime minister who became a top adviser to Greensill Capital, admitted to mistakes in lobbying policymakers on behalf of the recently collapsed lender. (FT) “We Asked Congress’s Freshmen to Give Up Stock Trading. Few Were Willing.” (NYT) Tech Court filings in Texas revealed that Google secretly used past bids for its digital advertising exchange to give its own ad-buying system an advantage over rivals. (WSJ) More than 500 employees of Alphabet signed an open letter demanding the tech giant change rules they say unduly protect those credibly accused of harassment. (The Verge) Best of the rest Don’t mistake a work colleague’s silent endurance for resilience. (NYT) Online schools are here to stay, even after the pandemic. (NYT) We’d like your feedback! Please email thoughts and suggestions to dealbook@nytimes.com. Source link Orbem News #Alibabas #Big #Fine #shot #warning

[lulew1988]

Graves disease has robbed me

Marie-Louise Pawsey, a lifestyle and dating coach from Australia, who also suffers, like myself with Graves Disease  has very kindly offered to share her story on The Thyroid Damsel. 

Here is Marie-Louise' story!

  Ten years ago, I was a newlywed. I’d met the man of my dreams a couple of years before, and we were fortunate to be living in Melbourne’s CBD in an apartment, unlike most of my friends and family.

During our first year or so, I’d had some issues with my eyes. I couldn’t explain it properly but they were sore, and I had vision issues. All my life my parents had gotten their eyes checked regularly; both wore glasses and my mum had had cataracts. So, I’d been getting my eyes checked every year since I was a teenager and I knew something wasn’t right. We weren’t living near my usual optometrist, so, I made an appointment with an optometrist nearby.

I was pretty much told that there was nothing wrong, but I knew there was, so I went to a second clinic, and was told a very different story but it still didn’t seem to really account for the issues I was having. Ugh!! So, I figured, I’d get a tie breaker, and went to a third. There, I was told that I needed glasses and they’d be prism lenses. I’d never heard of such a thing, but as I’d now had three very different stories, I did a fairly dumb thing, and I ignored them all. I battled on and just went about my business, planning my wedding, and my future. It’s amazing what you can put up with if you put your mind to it.

Six months later, we’d just moved into our new house. Within weeks I knew something was wrong. All the weight I’d been trying to lose in the leadup to our wedding was suddenly falling off, and I couldn’t figure out why. We’d moved from a one bedroom apartment to a three bedroom house, but I didn’t think that the extra walking around as I unpacked could have made such an impact. I didn’t even have much time to exercise since I’d given up the gym which had been in our apartment building, and now I had to commute 45min each way for work. So how was I shedding weight?

I started taking notice of everything. My appetite changed, I couldn’t sleep, but had heaps of energy, my heart race seemed to be that of a thoroughbred even as I woke in the morning, and I couldn’t concentrate on anything. And my eyes seemed to be getting worse all of a sudden.

So, I made an appointment with the GP I’d gone to for years- now that we were back in the area in which I’d grown up.

He’s amazing. I told him my symptoms and he immediately sent me to have blood tests to have my thyroid checked.

Within a week I was at an appointment with one of Melbourne’s leading Endocrinologists and the diagnosis was clear: I had Graves Disease.

When we’d moved, I’d taken a week off work to unpack, and during that time, I’d dropped in my old gym boss who had, on the spot, offered me part time work as a personal trainer.  It was fine for a little while, but my diagnosis meant that I couldn’t demonstrate exercises I wanted my clients to do, or workout alongside them. So I had to adjust by demonstrating once, and then issuing instructions to them verbally. I also had to explain to them what was going on with me, which was scary and revealing, as I didn’t fully understand it yet.

I found I could eat anything I wanted and not gain weight, but I didn’t have much of an appetite. My husband had to beg and plead for me to eat, and sometimes he’d resort to spoon feeding me. Looking back, I’m sure that there were times when I was determined to put the surprise weight loss to good use and capitalise on it. Other times I gorged on chips and chocolate, revelling in the idea of not gaining weight. I was all over the place, mentally and emotionally.

 But as the 15 tablets a day (14 x neomercazole and 1 beta blocker) kicked in, that all changed, and all the weight I’d lost came back with a vengeance. Alas, the snacking habit was a hard one to break, and it’s still one I battle now.

I also experienced trembling legs, increased bowel functions (spontaneously at times), anxiety, intolerance to heat (and I was diagnosed in summer so that explained why I complained more than others did!), erratic sleeping patterns and a myriad of eye problems that effected my work, driving and leisure time.

I’d gone to my original optometrist about my eyes and he’d recommended an ophthalmologist who diagnosed Thyroid Eye Disease. That explained a lot! The problem was that it meant that I’d need special glasses, (prism lenses, can you believe it?) and until they could get them, I wasn’t allowed to drive. I was the sole driver in the family, so that threw our whole routine out. We could no longer visit friends and family on the weekends if it meant driving and our shopping had to be done locally. All of this was a massive adjustment for us, and it caused a great deal of cabin fever for a couple who was used to going to the country every few weeks and being able to do normal day to day activities without restraint.

Not driving was a really good idea too, because despite being back in my old neighbourhood, I suddenly had memory problems. I found, and still find, that I could drive to the same place two days in a row, from the same starting point, and I’d get lost on the second day. I can envisage where I have to get to, and I know where I am, but can’t figure out a way to go, and even if I do figure it out, I’m uncertain about it. Google maps has become a very handy tool for me, but road works and detours completely throw me.

That’s okay now, but back then, I worked at night and drove across town to work. Fortunately, my boss was willing to adjust my hours, so I worked 4 longer nights a week, and was able to get there by train. This meant walking to and from the station, and anywhere else, which added a little more exercise into my routine.

I’d increased my exercise output, but was constrained to walking because I wasn’t allowed to get my heart rate up. I was never really able to convey the fear I felt about having a heart attack. I wore a watch with a pulse monitor and checked it repeatedly, but even when I wasn’t wearing it (in bed, in the shower) I could tell when it was high because my heart would race and then seem to stop. Ten years later, I still have those palpitations and when they become too regular, I go and get checked again.

I began walking 2-4 hours a day. It was one thing that helped me feel as though I had some control over the disease. I really put a lot of effort in, and changed my diet after seeking the help of a nutritionist.

I viewed some of these lifestyle changes as adventures. Certainly, going to work for 4 days was a nice change, and my increased energy meant that I didn’t struggle to work those 12 hours in a day. Seeing the world through a train window gave me new insight into those around me. But those things, I could take or leave.

Inside, however I was changed forever. I determined that I wouldn’t see myself as a victim, but went about making the necessary changes, and following instructions from my doctors.

Along with my endocrinologist, I had my optometrist, ophthalmologist, nutritionist, GP, and later I added a fertility specialising gynecologist. I did the rounds regularly, and it was an emotional and costly venture. The endo appointments need to be paid in full on the day, but are then reimbursed in part by Medicare. The appointment cost around $120 and I’d get about $70 of that back, if I recall. But that meant going to a Medicare (in the early days) office to lodge and claim. Those offices aren’t everywhere, so I’d tend to build up a few claims and do them all at once. So this meant that I was out of pocket all the appointment money until I could get to an office.

In Australia, not all tests are covered by Medicare, and it also depends on which doctor you go to, as to whether your appointment is bulk billed or not. Bulk billed means it’s free for the patient, but other places charge, usually $30-$60. When you factor in appointment costs, on top of medication costs, my extremely expensive glasses, money spent on healthy food, public transport when I was using it etc, all added up and my new life was costing me a small fortune.

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One such instruction that my endo issued was that we had to put our baby making on hold. We’d planned to move into our house, live there for a year or so to get used to married life, and then start having babies.

We were told that that plan was on hold until I was told otherwise. That was heartbreaking for me. I wasn’t someone who’d yearned for babies all my life, but now that I’d found my husband, I was keen for them.

Except that was a decision which was taken out of my hands.

For three years, I took my medications, walked and walked, ate, and managed my illness as well as I could, and finally, I received the news I wanted to hear: I was in remission.

I didn’t realise at the time, but I’ve been experiencing anxiety for a long time now. I’ve always been organised but wouldn’t have said I was a control freak, but now, if plans change too greatly, the effect on me is immense.

Over the years, I’ve realised that the disease has flipped my life completely, and if I could control anything- when the disease controlled me- it gave me a sense of balance. But there really is no balance. The disease is in control, and in some ways, the sooner I realised that the better. It wasn’t going to adjust to me, so I had to adjust to it.

But along the way, it robbed me of so much, and that’s something I struggle to accept, even today.

If you loved Marie-Louise' post as much as I did. You can follow her on social media and at her blog! 

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